The world has become older and older every day so we should know major problem for old people and how to improve their quality of life

1. Ismail Sadek

2.  The world population has never been as mature
as now. Currently, the number of people aged
60 and over is more than 800 million.
 Projections indicate that this figure will increase
to over two billion in 2050. Soon the world will
have a higher number of older adults than
children.

3. Contrary to common sense perceptions,
the majority of older people live in low-
and middle-income countries, and some
of the fastest rates of ageing are
occurring in these areas

4.  Low risk of disease and disease-related disability
 High mental and physical functioning
 Active engagement with life
 The combination of these three factors
constitute the essence of successful aging

5. Common-sense practices
 Don't smoke
 Don't drink too much
 Eat a healthy diet
 Get at least 30 minutes of moderate physical activity each
day
 Get regular checkups and screenings
 Wear seat belts and take other safety precautions

6. Attitudes and actions can transform our lives
 Lifelong learning
 Active involvement
 A hopeful outlook

7.  Maintain a positive outlook on life
 Take good care of your health
 Remain active
 Stay in close contact with family and friends
 Eat right
 Remain mentally active
 Know what you believe

8.  Quality of life is the degree of need and satisfaction within the
physical, psychological, social, activity, material and structural area.
 Quality of life is a state of well-being which is a composite of two
components: 1) the ability to perform everyday activities which
reflects physical psychological, and social well-being and 2) patient
satisfaction with levels of functioning and the control of disease
and/or treatment related symptoms.
 An individual’s perception of their position in life in the context of
the culture and values systems in which they live and in relation to
their goals, expectations, standards and concerns.

9.  Many possible definitions
 Multi-dimensionally
 Subjective
 Related to society

11. depression
movement
disorders
psychosis
dementia
SYMPTOM OVERLAP:

12. depression
movement
disorders
psychosis
dementia
Depression with
dementia
(“pseudodementia”)
Dementia with
depression
PD with depression
PDD, LBD, AD
with movement sx
PDD, LBD,
AD, VaD
with
psychotic sx
Psychotic
depression
Schizophrenia
with depression
Schizophrenia
with cognitive
deficits
Schizophrenia with
movement disorders
PDD, LBD, PD+ with
cognitive deficits
med conditions
& drugs
OVERVIEW: Consider main
syndrome & comorbid conditions
Vascular depression
with mild cognitive
impairment
MCI with depression

13. Depression is the most frequent cause of
emotional suffering in later life and frequently
diminishes quality of life.
A key feature of depression in later life is
COMORBIDITY---
e.g., with physical illness such as stroke,
myocardial infarcts, diabetes, and
cognitive disorders (possibly bi-
directional causality)

14. Depressive symptoms are less frequent or no more
frequent than in middle life. However, may be due to
under-reporting , survivor effect, and case finding.
Clinically significant depression in community dwelling elderly: 8%
to 16%, with major depression being about 2%. The 1-year
incidence of clinically significant depression is highest in those age
85+--13%
Depressive mood disorders decrease with age but depressive
symptoms are more frequent among the old-old(age 75+) but may be
due to factors associated with aging such as higher proportion of
women, more physical disability, more cognitive impairment , and
lower income. When these factors are controlled , there is no
relationship with age.

15. Prevalence of depression among older persons in various settings:
Medically and surgically hospitalized persons—major depression 10-
12% and an additional 23% experiencing significant depressive
symptoms.
Primary Care Physicians: 5-10% have major depression and
another 15% have minor or subsyndromal depression.
PCPs may not be aggressively identifying and treating depression
Long-Term Care Facilities: 12% major depression , another 15%
have minor depression. Only half were recognized.
Approximately one-fourth of medically
ill persons suffer from clinical
depression!

16. •Pseudodementia—“depression with
reversible dementia” syndrome: dementia
develops during depressive episode but
subsides after remission of depression.
•Mild cognitive impairment in depression
ranges from 25% to 50%, and cognitive
impairment often persists 1 year after
depression clears.

17. Cognitive
risk
Cerebro-
vascular
lesions
& risk
factors
Apathy,
motor
retardation
Late-onset depression—look for this triad:

18. Bereavement(loss of a love one through death)
Grief (psychosocial reaction to any loss such as depression,
anxiety, guilt, anger, etc)
•Approximately 800,000 older Americans are widowed each year.
•Acute grief: traumatic distress, separation distress, guilt/remorse,
social withdrawal, preoccupation with images of dead person---
approximately 6 months---leads to Integrated Grief as a background
state (reestablish interests, accessibility of memories of deceased but not
preoccupied,more positive emotions)

19. •Prolonged (also termed “complicated,” “traumatic”) grief: instead of
transition form acute to integrated grief person fails to accept the
death, guilt persists, overlap with major depression and/or PTSD
•Very highs levels of symptoms after 1 month—about two-fifths meet
criteria for major depression; in one study, at one year, 16% met
criteria for major depression. Thus, roughly between 10-20% of widows
develop clinically significantly depression in the first year of
bereavement .
•The presence of any substantial symptoms of depression at 2 months
after a loss was associated with a significant increased risk of continued
problems with depressive spectrum disorders. Other risk factors
include personal/family hx of depression, depression at time of loved
one’s death,poor medical health, younger age of survivor

21.  The quality of life of older people is a complex and
multidimensional issue. There is no single definition of quality
of life for older people, so we aim to break down quality of life
of older people into the domains that are most important to
them
 the main domains are reported as follows: health;
psychological well-being; social relationships; activities; home
and neighbourhood; financial circumstances; and spirituality
and religion.

22.  Bowling (2005) emphasizes that theories on ageing have
moved away from the traditional negative models to more
positive ones.
 Health status is treated by gerontologists and other
academics as an important influence on quality of life. As
ill-health may result in physical and/or psychological
dependency, older people frequently nominate health as
an important element of quality of life.

23.  Indeed, Bowling et al. concluded that ill-health is
the most negative influence on quality of life;
 There was no difference in the weights assigned to
health by the older and younger age groups
interviewed. This implies that the domain of health
is important at all ages.
 Being healthy allows respondents to participate in
activities, thus contributing to feelings of
enjoyment and having a role in life.

24.  Psychological well-being is important for quality of life. Indeed,
psychological well-being and quality of life are sometimes
interpreted as meaning the same thing.
 A positive outlook on life was believed to contribute to quality
of life. It is referred to being optimistic, satisfied, believing
that one had a role in life and also having happy memories of
the past.
 Those who spoke of the negative effect of a poor psychological
outlook were more likely to be suffering from anxiety or
depression (or other psychiatric morbidities).

25.  There is conflicting evidence from the literature in relation
to disability and self-esteem. On the one hand the
literature indicates that self-esteem is negatively
associated with the severity of disability and disease
progression.
 Alternatively it is suggested that satisfactory
psychological adjustment is possible despite the extent of
disability or seriousness of disease progression.

26.  With regard to the older person and self-esteem,
the literature is also ambiguous, with some
research indicating that self-esteem reduces in old
age and others indicating an increase or no
change.
 Self-concept is related to self-esteem in that
‘people who have good self-esteem have a clearly
differentiated self-concept’.
 In relation to intellectual disabilities the literature
indicates that this group are more at risk for low
self-concept and, hence, low self-esteem.

27.  Social interaction with people, including connectedness to
family and friends, is usually beneficial and a positive influence
on quality of life.
 People who are not connected to others often experience
loneliness, which detracts from quality of life.
 That said, loneliness is not always mentioned by respondents
in response to quality of life surveys, but this may be due to
the stigma attached to being lonely.
 However, older people sometimes mention being afraid of
feeling lonely as a result of a decline in social networks due to
illness and death among friends.

28.  Good social relationships were critical to quality to life.
Individuals emphasized the emotional and practical
support provided by children and grandchildren. This
support was often through face-to-face contact or by
telephone. They felt they were able to play a reciprocal
role by taking care of and helping their grandchildren.

29.  Aspects of social relationships that detracted from quality of
life included
1. difficulties maintaining contact,
2. family disputes or
3. family members not having enough time to visit.
 The importance of family and social relationships is also
highlighted in other studies. and found that those with the
highest self-rated quality of life had ‘excellent’ or ‘good’ social
support.

30.  The environmental approach to quality of life posits the theory
that an individual’s physical and social environments affect
quality of life.
 Furthermore, quality of life is dependent on how an individual
relates to, and perhaps adapts to, environments that are not
ideal.
 If the structures that help people relate to their neighborhoods
aren’t in place, then this may affect quality of life. For
example, a lack of transport facilities may prevent an older
person from leaving their home, thus substantially reducing
their ability to interact with the local and regional
environment.

31.  The main factors in the category of home and neighbourhood
were:
1. living in a safe,
2. secure, friendly area;
3. having friendly, helpful neighbours; and
4. the availability of good local facilities.
5. The availability of Council services, including refuse
collections and
6. having pleasant landscapes and surroundings.
 Independence was also mentioned in relation to the
availability of reliable and frequent transport services.
 The individuals with the highest quality of life also had the
highest satisfaction with their residential environment.

32.  Various studies have found a positive correlation between
engagement in meaningful activities and quality of life.
 What tends to be missing is elaboration on how the
process of engagement influences quality of life.
 Nevertheless, almost two thirds of respondents in Bowling
et al.’s study (2003) indicated that involvement in social
activities, and local community and voluntary
organizations contributed to a good quality of life.

33.  The importance of ‘having things to do and taking part in
life was discussed by all respondents in the Grewal et al.
study (2006). Activities identified included
1. travel,
2. bridge,
3. politics,
4. continuing to work and
5. helping other people.
6. Activities were also associated with feelings of self-worth
and having a role in life.

34.  Bond and Corner (2004) referred to the changes in financial
circumstances which have taken place over the last century.
 They pointed out that the number of people in absolute poverty has
declined dramatically. Absolute poverty occurs when individuals
cannot afford the basic necessities in life.
 However, relative poverty for older people has increased in many
countries. Relative poverty occurs when one is financially worse off
than others, but has sufficient money to live on.
 As individuals are inclined to compare themselves to others, being
relatively poor may detract from an individual’s quality of life.

35.  There is difference between religion and spirituality. The
former is associated with powerful religious organizations,
whilst the latter is a private, subjective experience.
 Even if church attendances have fallen, this does not
mean that spirituality will have little influence on quality
of life of future generations of older people.

36.  However, attending a place of worship was mentioned by
respondents and was recorded by the authors under the
domain of activities. Spirituality was also mentioned by
respondents but it was recorded in the psychological well-
being domain.
 A study which assessed the influence of spirituality, religion
and personal beliefs (SRPB), using the WHO Quality of Life
measure, found that SRPB was an influence on quality of life,
but was not as important an influence as environmental,
psychological or social domains (WHOQOL, 2005).
 However, SRPB plays a part in an individual’s ability to cope
with illness and stress, and maintain well-being.

37. Maintaining Emotional Health

38. 1. A measure of personal life satisfaction and
quality of life that affects the older
individual and the community
(www.asaging.org)
2. “Striking a balance in all aspects of your life
– social, physical, spiritual, economic,
mental”
(www.stjosham.on.ca/mentalhealth/about.htm)

39. 3. Successful performance of mental function,
resulting in productive activities, fulfilling
relationships with other people, and the ability to
adapt to change and to cope with adversity…
mental health is the springboard of thinking and
communication skills, learning, emotional
growth, resilience, and self esteem
(www.surgeongeneral.gov)

40.  Good mental health can help you
 Enjoy life more
 Handle difficult situations
 Stay better connected to your loved ones
 Keep your body strong
 Save money on healthcare expenses
 Live longer
(DHHS publication No. [SMA] 02-3618, 2001)

41.  Most older adults enjoy good mental health
 Emotional, mental, and physical health are all connected
 A healthy mind is as important as a healthy body, and should
be given the same attention!

42.  Sleep is an important part of our ability to
remember
 Neuronal connections may be
remodeled during sleep
 Some memory tasks appear to be more
vulnerable to sleep deprivation than
others
 Sleep deprivation may produce effects
in the brain that resemble those
associated with aging
 Evidence that sleep plays an important
role in memory consolidation
(http://www.memory-key.com/NatureofMemory/sleep.htm)

43.  Managing stress can affect one’s outlook on life
 Not all stress is negative
 Chronic stress takes a toll on the brain
 In older persons, stress is thought to play a bigger role in
triggering depression than in other groups

44.  Eat regular healthy
meals
 Avoid caffeine
 Get enough sleep
 Engage in some kind
of regular physical
activity
 Recognize that there
are some things you
cannot control and
focus your attention
on the things that you
can
 Develop a sense of
humor; put some fun
back into your life by
doing something you
really enjoy every day

45. Staying Connected

46.  Maintaining social connections is important to
wellness in later life
 Social relationships serve as a key source of
informal support
 Loneliness is a problem for many older adults

47. 1. Take a slow exit
2. Try a new job on a part-time basis
3. Share your job
4. Take a break
5. Volunteer

48. Dealing with Grief

49.  Denial
 Anger
 Reactive Depression
 Guilt
 Acceptance

50. Take care of body
Take care of mind
Take care of spirit